Abstract
Purpose This study aimed to describe and compare the performance of two screening protocols used for preschool hearing screening in resource-constrained settings. Method Secondary data analysis was done to determine the performance of two protocols implemented during a preschool hearing screening program using mobile health technology in South Africa. Pure-tone audiometry screening at 25 dB HL for 1000, 2000, and 4000 Hz in each ear was used by both protocols. The fail criterion for the first protocol (2,147 children screened) constituted a no-response on one or more frequencies in either ear. The second protocol required two or more no-responses (5,782 children). Multivariate logistic regression models were used to investigate associations between outcomes and protocol, age, gender, and duration. Results Fail rates for the one-frequency fail protocol was 8.7% (n = 186) and 4.3% (n = 250) for the two-frequency fail protocol. Children screened with the two-frequency fail protocol were 52.9% less likely to fail (p < .001; OR = 0.471; 95% confidence interval [0.385, 0.575]). Gender (p = .251) and age (p = .570) had no significant effect on screening outcome. A percentage of cases screened (44.7%) exceeded permissible noise levels in at least one ear at 1000 Hz across both protocols. True- and false-positive cases did not differ significantly between protocols. Protocol type (p = .204), gender (p = .314), and age (p = .982) did not affect the odds of being a true-positive result. Average screening time was 72.8 s (78.66 SD) and 64.9 s (55.78 SD) for the one-frequency and two-frequency fail protocols, respectively. Conclusions A two-frequency fail criterion and immediate rescreen of failed frequencies significantly reduced referral rate for follow-up services that are often overburdened in resourced-constrained settings. Future protocol adaptations can also consider increasing the screening levels at 1000 Hz to minimize the influence of environmental noise.
Highlights
This study aimed to describe and compare the performance of two screening protocols used for preschool hearing screening in resource-constrained settings
Key enabling factors in these mobile health (mHealth) supported screening models are the utilization of community health workers (CHWs) and automated screening applications with preset protocols and advanced quality control measures that enable CHWs with minimal training to undertake screening (Dawood et al, 2020; Eksteen et al, 2019; Manus et al, 2021; O’Donovan et al, 2019; Swanepoel, 2020; van Wyk et al, 2019; WHO, 2021)
During the course of the screening, two protocols that differed in fail criterion were used: (a) one-frequency fail protocol: No response at one or more frequency across both ears constituted a fail result; and (b) two-frequency fail protocol: No response at two or more frequencies across both ears constituted a fail result
Summary
This study aimed to describe and compare the performance of two screening protocols used for preschool hearing screening in resource-constrained settings. There are various challenges to the implementation of population-based hearing screening in the educational settings These include variable protocols for testing and referral criteria, less than ideal test conditions, limited human and technology resources, competing national health priorities, and poorly integrated electronic data management systems (Bamford et al, 2007; Prieve et al, 2015; Stenfeldt, 2018). Key questions still exist in planning hearing screening programs in resource-constrained settings such as the targeted hearing loss and protocol considerations (e.g., intensity levels and fail criteria) to minimize false positives and over referrals to resource-constrained health facilities. In resource-constrained settings, where referral rates and false-positive screening outcomes burden pressurized health facilities, the performance of a two-frequency fail protocol should be investigated and compared to the performance of a one-frequency fail protocol in the field.
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